Depression is classified today as a mood disorder, it's a bit like calling malignant tumour; "a disorder of cell growth"- it is helpful, if someone knows enough about the cells. This mysterious disease is according to the World Health Organization fourth, most serious health problem in the world! Until recently, due to poor social knowledge and lack of clear causes of morbidity and bad state of the "ill" patient, it was was often neglected. A person with depression either did not admit to it, or was left to him/herself and put off with the words "pull yourself together". Nowadays more and more people recognize the essence of the disease, we begin to know "what depression is" and another myths about antidepressants are subverted.

THE REASONS OF DEPRESSION

There are many hypotheses trying to identify sources and causes of depression. This disease is complex and multifaceted, so its surface is believed to be factors in both the biological and psychological, genetic, environmental or cognitive. Each of the hypotheses brings new knowledge and perspective on the genesis of the disease, but none of them is able to explain all its aspects. The biological hypothesis explains the basis of endogenous depression by malfunctioning central nervous system at the cellular and protein level. Although the gene responsible for depression has not been discovered yet, this hypothesis also draws attention to the individual susceptibility to the disease, if there are depressive people in the family. Scientists have found a few places the human genome, which differ in construction of healthy subjects and those suffering from depression, which confirms the biological aspects involved in the disease.

Amid the psychological causes of depression are mentioned among the others:

negative way of thinking

accepting the blame for the unfortunate situation

belief that nothing good will happen to me

remembering the bad events rather than happy ones

self-strengthning of depression

depressive distortion of memory, memories

submissive pattern of behaviour

experiencing feelings of embarrassment, fear and withdrawal, rather than addressing the challenges

deposition of problems, not making attempts to solve them

education errors

quarrels and conflicts at home

embarrassing a child as a method of education

favouritism of siblings

excessive demands

psychological abuse, sexual harassment - the so-called. bad touch

vicious circles of behaviour and depressive thinking

Studies of the socio demographic characteristics made ​​it possible to extract the depression risk factors that are associated mainly with gender, age, family situation and socio-economic status of the patients. Women are twice as likely to struggle with depression than men, it is also proved that tendency to depression increases with age - statistically mostly depression occurs in people over 60 years of age. In addition to bipolar disorder, which, according to research is rather met in environments with high social and economic status, it was thought until recently that, in most cases, depression relates to poorer communities and those that are in some way deprived. Recent studies suggest that depression affects equally all backgrounds, individuals that are weakly as well as better-off, people with higher and basic education. Among those who are divorced and separated the likelihood of depressive mood is higher than in those remaining in the relationship or single.

Depression often occurs in people suffering from somatic diseases: coronary heart disease, diabetes, after having a stroke, cancer, hypothyroidism and also in specific periods of life such as after childbirth, menopause. In old age it is also sometimes confused with dementia. It also happens that the disease is caused by some individual life events. Depression occurs in connection with the widely understood loss, frustration, humiliation, or on the contrary - is associated with the implementation of the long-awaited goal or achieving the desired success. Depression may also develop when it comes to the sum of the two types of predisposing factors – factors related to the events of early childhood as well as accelerating factors - related to the events that took place recently. One of the most popular contemporary theories pointing to the substrate of depressive mood is Aaron Beck's cognitive theory. Beck proves that people suffering from decreased mood use the patterns of thinking that cause depression. According to him, the patients filter the information in such a way that they extract only the negative aspects. This is reflected in the thinking of people affected by depression, which is full of pessimism and gloomy pictures concerning three specific areas by determined by Beck – a person him/herself, the environment and the future. In spite of appearances, depression affects also young people and even newborn babies - Spitz introduced the term anaclictic depression, which refers to the disorder observed in the neonates and infants and which is a disorder associated with isolation from the mother (for example because of the child's stay in hospital, or placing the baby in an orphanage). The picture of the anaclitic depression includes:

loss of appetite,

rhythm disturbances of sleep and wakefulness,

low mobility,

no typical for this developmental period, the reaction of tears,

symptoms of dyspepsia,

loss of suction,

sometimes episodes of hyperthermia

Anaclitic depression subsides within 3 months after the mother-child connection.

In Poland, about 40% of teens have emotional problems, and some of them suffer from depression. The survey conducted in 1981-1985 by prof. Jacek Bomba, a psychiatrist and specialist in the field of young people depression showed that s almost 20% seventeen year old people suffered from depression then. According to a survey conducted two years ago by prof. Jaklewicz Hanna of the University in Gdansk, among a group of students from three classes of secondary schools, almost 50% of learners in secondary schools and 65% of their peers from vocational schools suffered from depression. As many as 25% of them required treatment. Depression more and more often happens to young people, who fear that they are condemned to live a poor life without any prospects. This applies especially to the vocational schools students, but also to the learners of secondary schools who feel that they dropped out of the race to career. According to prof. Jacek Bomba each person between 13 and 16 suffers from adolescent depression. At this stage where one needs to change his/her relationship with the parents, becomes independent and starts to decide on his/her future career. If a young man at that time gets support from the family or from other close friends, he/she can pass this stage without problems. However, if he/she does not receive this support , unrest may develop into a deep anxiety, and disorders may take the form of depression. The most exposed are the children of unemployed parents but also parents whose career has reduced time spent with the family. Huge ambitions of parents are often the additional factor of youngsters' depression. They want their child to be like them or sometimes absolutely different. They want their child to manage in his/her life, to be the best of his/her peers and to fulfil hopes for a great career. Not all children decide to tell their parents about their fears and not all parents are vigilant enough to notice the problems of their children. Kepinski has identified four basic forms of adolescent depression: apathetic/ abulic, rebellious, resigning and labile. According to professor Jacek Bomba, in a situation where a child is ill, family therapy is the most important. Unfortunately in Poland it is much less common than drug therapy which is much cheaper. However, as the professor says, it is not always effective.

SYMPTOMS OF DEPRESSION

Depression is a multifaceted and complex phenomenon. There are many types of depression, but the diagnosis of each is similar. Www.depresja.net.pl provides two basic types of depression: endogenous and dysthymia. One source of help in the diagnosis of depression is Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition in the medical literature abbreviated as DSM-IV. DSM-IV , for diagnosis of a major depressive episode is needed at least a two-week period of decreased mood or loss of interest in almost all activities and pleasures coming from them. In addition, at the same time, there must be five or more of the following symptoms:

depressed mood for most of the day

reduction of interest and ability to experience pleasures

significant increase or decrease of weight

insomnia or hypersomnia

deterioration of control over body movements

feeling of fatigue

sense of worthlessness and guilt

decline in mental sharpness and concentration

recurrent thoughts of death or suicide

menstrual disorders, including the disappearance of bleeding

constipation

drying of the mucous membranes in the mouth

anxiety, lasting almost continuously, with undulating severity, until the panic attacks. Localized in the pericardium or abdomen

The condition of recognition of dysthymia (DSM-IV) is a depressed mood lasting for most of the days during at least two weeks. In addition, there must be no less than two of the following symptoms:

declined or increased appetite

hypersomnia or insomnia

weariness or lack of energy

lowered self-esteem

difficulties in paying attention or making decisions

feeling of hopelessness

Psychiatrist Danuta Byczynska notes that pre-specified characteristics must be achieved clinically relevant, because not every depression is a mental illness. These features are the most important in the diagnosis, but that does not mean that the only. She gives the most noticed and mentioned by patients in the consulting room parameters- they are both those that have been mentioned previously and also the new ones:

mood of sadness, regret, indifference

tiredness, loss of energy

isolation from the environment, abandoning the usual contacts

lack of interest in what has always attracted, as well as in important responsibilities

Meeting even a few of these features at the right intensity is sufficient for the diagnosis of depression. Other symptoms of depression appear for children and adolescents. Observable changes in behaviour are the basic symptoms of depressive disorders in children and adolescents and depending on the child's age, you can also extract symptoms such as:

for younger children:

avoiding playgrounds and peers

loss of appetite

excited states of the locomotor

crying or screaming bouts

sleep disorders

bed-wetting

faecal contamination.

children in early school age:

avoiding playgrounds and peers

learning difficulties

night fears

cry fit

bed-wetting

older children and during puberty:

hypochondria’s attitude

learning difficulties

lowered self-esteem

anorexia

obsessions

In adolescence, the image is often masked by the disease indications such as:

anxiety

boredom

tiredness

difficulties with concentration

outbursts of anger

escapes from home

antisocial and criminal acts.

A very serious symptom, which characterizes the advanced stage of the disease are the suicidal thoughts. Usually their occurrence is preceded by the thoughts of resignation and planning the suicide is for an ill person a natural consequence of the lack of hope and faith for the solution. Thoughts of a suicide can not be persuaded. It is impossible to convince a patient with depression who wants to commit a suicide that it is not worth, that life is beautiful, etc. This is due to patient's lack of criticism - he is able to assess himself, his future just from the position of depression. The occurrence of suicidal thoughts in depression always requires medical treatment, sometimes treatment in a psychiatric hospital - especially if the sick person lives alone or is dependent on him/herself, the more when the person alone takes care of the children. It is not always that suicidal thoughts are a symptom of depression. Depression is always recognized by the doctor who takes into account the overall mental condition of a patient. People with abnormally shaped personality (it can be a feature facilitating the occurrence of depression)may also have suicidal thoughts. It comes to thoughts of suicide in times of difficult problems, problems of life, the experience of deprivation (deprivation of essential goods for the person). These thoughts stem from a lack of ability to correct or constructive experiencing stress and are often used as a safety valve, escape.

TYPES OF DEPRESSION

Depending on the different sources can meet the different classifications of depressive disorders. Below are the most popular ones.

Endogenous depression (unipolar affective disorder, other depression proper, clinical depression, severe depression). There is no external cause, now it is believed that there is no consequence of any specific life events. Other sources say that it may arise in connection with an adverse event in life, but but also without it. It is caused by an unspecified disorder of brain function, especially hormonal or nervous system, for example biogenic amine deficiency, the decrease of nor-epinephrine (otherwise noradrenaline), and serotonin. This depression causes a profound disruption of mental and physical functions. Man can not perform the simplest actions (he/she has no strength ), he/she can not make decisions, often does not wash,or prepare food. The patient feels guilty, has suicidal thoughts almost always, sometimes with a tendency to pursue. Endogenous depression absolutely requires psychiatric treatment and in the most severe cases it requires hospitalization. Approximately 50% of patients try to commit suicide, 15% take his/her life in this way. Endogenous depressive episode lasts about 6 months, although this is not any rule. Recovery and return to normal life happens very often , but in many cases there are relapses, some patients need to take antidepressants for life.

Neurotic depression (dysthymia) Dysthymia is a chronic depressed mood lasting forat least several years. It has a milder course than endogenous depression. Cases occur most commonly in the age between 20 and 30 . The situation of people with dysthymia is usually very difficult - they are in almost constantly depressed mood, sad and often have a sense of hopelessness. Their life energy is extremely low, they lose interest, the characteristic is a lack of concentration, inability to focus thoughts. The first cause of dysthymia is a social maladjustment, which is perhaps a consequence of the deep trauma of the past: insecurity in childhood, traumatic events that led to the loss of goals, inability to meet and express the needs. The second type are determinants of biological and genetic factors similar or the same as in endogenous depression. The combination of pharmacological and psychiatric treatment is recommended in dysthymia .

Reactive (situational) depression is a reaction to a specific, difficult event in life. This could be the death of the loved one, job loss or break of relationship. The symptoms are typical for an episode of depression, but without some of the components of endogenous depression - feelings of guilt, delusions. Unusual, prolonged grief reaction usually lasts for several months, after which emotional state is slowly returning to normal. Although reactive depression does not require treatment, the very severe and painful symptoms can be (often should) mitigated by psychotherapy or support of loved ones.

Postnatal depression: It usually occurs between the fourth and sixth month after delivery, may increase gradually or begin suddenly at its most severe form, without any warning. Postnatal depression causes discomfort, both physical (huge fatigue) and mental (continuous sadness). Takes longer than the baby blues (appears shortly after birth and usually disappears after a few weeks), and the course is much acute its symptoms include: mood collapse, virtually no feeling of happiness, physical and mental fatigue which entails the difficulty or impossibility of household activities, problems of caring for the child and yourself, excessive focus on the health of the child or on the contrary - the decline of interest in the child, eating disorders (no eating or overeating), very frequent crying for no reason, loss of sense of time (mother feels no difference between the quarter of an hour and one hour), anxiety, sometimes panic attacks, loss of interest in sex, and possible somatic pain such as headaches, back, abdomen, heart palpitations. Postnatal depression affects every six women, and treatment is based on psychotherapy and in the most difficult cases, antidepressant medication safe for nursing mothers.

Seasonal affective disorder (abbreviated SAD) it takes the form of periodically recurrent depressive episodes in certain fixed times of the year. Seasonal depression must be distinguished from the clinical, emotional changes which occur at a deeper mental level and regardless of the season. Seasonal affective disorder is usually divided into winter and summer, but the former is much more common. Distressing symptoms of SAD appear regularly in late autumn or in winter. These are: the apparent lack of energy, sadness, hopelessness, high sleepiness, cravings for sweets and the associated weight gain, irritability, poor concentration, lack of motivation to act, as women are concerned intensification of the symptoms of premenstrual syndrome. It is assumed that in the liberation of winter affective disorders deficiency of the sunlight has an important role. Its incidence increases with latitude, and hence the reduction in length of a day and number of sunshine days of a year. In our latitude, the intensity is in October or February two to three times lower than on a sunny spring day and up to 100 times lower than on the beach in summer. In in the darkness, our body produces more melatonin - the hormone which causes that we are sleepy, tired and apathetic. SAD is a quite common disease - a mild form of it affects about 10% of Poles, about 3% passes the more acute ailment. Particularly sensitive to fluctuations of melatonin levels are women between twenty and forty years of age who suffer from it about 2-3 times more often than men. Also children may suffer from SAD. Then they have big problems with getting up in the morning as well as difficulties in concentrating and doing homework, they often fall asleep during the classes. A popular and effective remedy for a winter depression are primarily outdoor activities and social contacts. But if the symptoms persist, you should consult a physician. In recent years, there are attempts to heal seasonal affective disorder. One of the methods is photo-therapy, that is light therapy. For many people, it alleviates or even eliminates the symptoms of depression. Symptoms, when a dose of light is selected appropriately for the patient, will start to recede after a week of treatment. The effectiveness of photo-therapy reaches 60-80%. Another methods of winter depression treatments may be acupuncture, psychotherapy or antidepressants.

Bipolar depression (manic – depressive disorder , manic – depressive psychosis): is characterized by alternating states of mania, depression, and health. It is the heaviest of the cases described here. The first attack of the disease occurs most often between the 20 and 30. Depressive episode is the same like in the endogenous unipolar depression. Manic episode is characterized by an exhilarating mood, increasing self-esteem, accumulation of thoughts, the patient feels that he can move the mountains. The changes resemble those induced by psychoactive substances. such as amphetamine, and they tend to be pathological. A single manic episode usually lasts from several days to several months. The causes of this disease, as well as other depressions, are essentially unknown, the most popular hypotheses indicate: poor work of neurotransmitters, brain trauma and micro trauma, defects at the stage of fetal development and genetic factors. Bipolar depression is extremely debilitating and often makes it impossible to continue working, unusual states of the patient generally lead to the corruption of all social contacts. Bipolar disorder is often followed by alcoholism. The ratio of suicides and suicide attempts is very high, one-fifth of patients receive their own lives .

Symotomatic depression occurs in the course of different somatic diseases, for example: in thyroid dysfunction, atherosclerosis, diabetes, liver damage, kidney damage, psoriasis, lupus erythematosus, rheumatoid arthritis, cancer, anaemia, chronic thallium and lead poisoning. It may also appear in the course of taking certain medicine, for example some hormonal contraceptives, antihypertensives, neuroleptics, cholinergic compounds, anti-Parkinsonian, of the noradrenergic action (for example amphetamine), antihistamine and anticancer. The incidence of such complications is observed with approximately 20% of patients.

Organic Depression: depression in organic diseases of the central nervous system. This depression is sometimes a prelude or a basic clinical picture of the the disease process. The clinical picture is either a chronic condition of a not very large volume in which one can find: the blues, hypochondria chronic anxiety, sleep disorders, or on the other side great excitement, developed catastrophic hypochondriac, nihilistic delusions and suicidal tendencies. Dim drug efficacy and greater than average risk of side effects within the central nervous system are observed but still the condition is chronic. It occurs when Alzheimer's disease, Huntington's chorea, Parkinson's disease, hepato-lenticular degeneration, brain tumours ((especially the frontal and temporal lobe), cerebral atherosclerosis, cerebrovascular insufficiency, post-traumatic, meninges haematoma and subdural haematoma, damage to the frontal and temporal lobe, sclerosis multiple and hydrocephalus.

Existential depression Haefner has used this term for disorders that fit neither endogenous nor reactive depression. It follows the experiences of man's life, his philosophy and personal goals. Such a depression is a sign of "existential failure", loss of life goals, opportunities and needs of self – realization. Winkler distinguishes three types of existential depression: depression as a result of impairment, depression resulting from the continued long-term feelings of guilt, and nihilistic depression.

Abortive depression (masked, sub-depression) all symptoms of depression are present but they are mild or a group of non-specific for depression symptoms is present for example: only sleep disturbances, headache, obsessions, fear. Most patients report because of insomnia. Atypical depression can also take pictures of anorexia with significant weight loss.

Depression of alienation identified by Burger-Prinz as chronic depression, which sometimes occurs in large social groups as a result of alienation. The character of this disease is a special case of reactive depression lasting for years. This not only alienation but also long-term hardship,discrimination, harassment as an endless source of trauma. The nostalgia of immigrants is related to this.

Depression of relief defined by Schulte and Rufin, form of depression which is observed in people who have freed themselves from the obligations, long-term mental stress. For example: in people who have left prison, but also during holidays, or during other public holidays. Fill in the test for workaholism on our website. From it you will learn if you are already threatened, and how to deal with this dangerous condition. Kepinski pointed out that this type of depression also occurs in people who have been successful, for example in situation when after years of striving, struggle, finally reaches the desired goal. Such a depression is called the summit depression.

Depression of exhaustion after long-term emotional load, for women often a result of failures in life, marriage and family relationships. They show the excessive sensitivity, tendency to worry, even trivial matters takeover. In men, according to Kielholz the source of the depression are: being overloaded at work, conflict situations at work and at home, and at the same time accented personality traits such as perfectionism, ambition, when the aspirations and goals often exceed their emotional or intellectual possibilities.

Depressions in the reaction of mourning Parkes distinguishes the following phases of this form of depression:

The first - the state of torpor and emotional indifference, preventing the consciousness.

The second - pity, despair, tears, some people react with anger and rage at the same time.

The third - sadness, anxiety and focusing all the feelings on the person who died, abolition of activity, sleep disorders and somatisation and total disorganization of complex activity, which can cause that these people are completely unable to work.

Demanding attitudes often appear, sometimes even hostile to the doctors or nurses. This period, is followed by significantly increased incidence of diseases, including cancer and high mortality rates. According to Rees and Lutkins incidence of mortality among the bereaved is a 10 times higher than in the control groups.

Depression of old age: This is often depression with delusions and motor excitement; accompanied by a large anxiety, fearful mood, irritation, often with rich emotional expression, crying, wailing, despair, and sometimes panic. Patients report numerous hypochondriacal complaints, which sometimes reach the size of delusions of the incurable disease (Cotard syndrome) .The most common complaints are: itch, stinging, muscle pain, tissues, organs, burning of the skin, delusions of the total material defeat and ruin, a hopeless situation. They expect death from starvation for themselves and for the family, they accuse themselves of committing prohibited acts, admission to crimes, sins, sometimes so severe that they have no adequate punishment or penance. Some expect arrests with terror, conviction, court sentence, others they are willing to punish themselves, and therefore they refuse to eat or reveal suicidal tendencies. Others publicly accuse themselves. Frequently these symptoms are accompanied by the sleep disorder and major psycho-motor disorder. On the other side symptoms of apathy may appear, abulia, loss of interests, state of indifference, feeling of reduced efficiency, particularly mental. The clinical picture often resembles dementia. It happens that depression and dementia occur in parallel. Then the memory and impairment cognitive deficit appear.

Alcohol Depression: is accompanied by a dependence from alcohol.

DIAGNOSIS AND WHAT NEXT?

When you face depressive symptoms you should immediately contact a specialist - Like other illnesses, depression requires the right treatment. Fortunately the time of lobotomy (It consists of cutting the connections to and from the pre-frontal cortex, the anterior part of the frontal lobes of the brain) passed long time ago. The most common treatments for depression are antidepressant medications and psychotherapy. Occasionally, there are studies of drugs directed primarily at the treatment of depression - most drugs have been discovered through the study of other diseases, such as the use of chlorpromazine in the treatment of allergies. When testing antihistamine preparations on rats it was noted that under the influence of one of these animals lost interest in things around them, and were overwhelmed by an unusual calm. Given to people, this preparation endured mental tension and effected generally reassuring, and used in schizophrenia has proved to be an effective treatment for this disease. What is more, the first positive signs of the drug effectiveness occurred several hours after ingestion. In the forties was examined also in terms of properties of antihistamines and anti - Parkinson, preparations of the chemical structure roughly similar to chlorpromazine. Currently they are known as tricyclic antidepressants. In the treatment of depression several types of drugs, or thymoleptic drugs. The therapeutic effect of all measures is, according to present knowledge, the intensity of synaptic conduction by increasing the amount of neurotransmitter – mainly serotonin and noradrenaline – in the brain. Their action removes mental depression without co-stimulation, so you just endure depression by improving mood. Most thymoleptic drugs also inhibit gastric acid secretion, and therefore are often used to treat stomach diseases. The best known of this group of drugs are: amitriptyline, desipramina, opipramol, nialamid. This does not mean that these are the only drugs on the market to help, depending on the type of depression and its causes apply medication with a different effect. Here is an exemplary of classification of them:

Thymoleptic drugs: 3 and 4-cyclic antidepressants (TLPD) which affect in different ways for anxiety mainly due to inhibition of re-uptake of norepinephrine and serotonin from the synaptic cleft and release of these neurotransmitters. These include, among the others, these substances:

Clomipramine, having an anti-depressant effect similar to imipramine and facilitates sleep

Doxepin, having an anti-depressant effect by increasing the concentration of neurotransmitters in the brain

Opipramol, when used with feelings of anxiety- having lowering effect on depressive

Fluoxetine, which inhibits the re-uptake of serotonin and catecholamines to a lesser extent. Assists in the treatment of obsessive compulsive disorder.

Paroxetine, a potent selective serotonin re-uptake inhibitor.

Sertraline, which reduces the re-uptake of dopamine, is also indicated for the treatment of phobias and anxiety disorders

Venlafaxine, which selectively inhibits the re-uptake of norepinephrine and serotonin, thanks to it increases the severity of conduction of electrical impulses in the brain.

Citalopram, which is an inhibitor of serotonin re-uptake

Escitalopram, which action also involves the inhibition of serotonin re-uptake, but is more selective than citalopram.

Fluvoxamine, a potent inhibitor of serotonin re-uptake.

Bupropion, which is an inhibitor of the re-uptake of dopamine and norepinephrine.

Trazodone, trazodone chloride, the action of antidepressant, is a potent inhibitor of serotonin reuptake.

Reboxetine - a potent inhibitor of noradrenaline re-uptake.

MAO inhibitors (monoamooksydaza): These drugs are never used with the drugs causing re-uptake of norepinephrine and serotonin, they have less toxicity than TLPD, or a similar potency, are used to treat depressive syndrome of agitation, anxiety and fear. These include moclobemide.

Antidepressants of different action:

Tianeptyna, which increases the release of serotonin and dopamine, what can cause euphoric states.

Mianserin, which is an antagonist of presynaptic adrenergic receptors and causes increased secretion of norepinephrine, dopamine, serotonin and acetylcholine.

Maprotiline, which has a broad spectrum of antidepressant

Normothymic drugs:

valproate,

lithium carbonate,

carbamazepine

Neuroleptics:

levomepromazine,

sulpiride,

chlorprotiksen,

flupentyksol

Although the use of pharmacological agents is necessary in the treatment of depressive episode, in the long term it usually turns out to be insufficient. Many years of practice indicates that drug therapy should be accompanied by appropriate psychological therapy, although there is a parallel position that because the source of depression and are typical and only psychological, the effectiveness of psychotherapy in the treatment of bipolar disorder is questionable. Proponents of the first position, note that psychotherapy allows the analysis of symptoms and their meaning, and thus offers the potential for therapeutic action. In the case of the patients with depression only psychoanalysis and maintenance therapy was used for a long time. Today the range of treatment options has expanded considerably. With great simplification it can be concluded that there are two major groups of methods - analytic psychotherapy for inspiration and short-term therapies. Methods of analytical inspiration are based on a return to childhood and finding unresolved psychic conflicts of the period. Becoming aware of these traumatic experiences, allows the patient to reduce their impact on his/ her current patterns of thinking and behaviour. Among the short-term therapies the cognitive and interpersonal therapies can be distinguished. The first is inspired by, discussed previously, the work of Aaron Beck, the other almost stress the fundamental role of the patient's adaptation to its environment. Their starting point is the assumption that any depressive disorder causes abnormally functioning relationships. The main objective of this therapy is therefore to improve the patient's interpersonal skills and develop his ability to deal with the world. There are many recognized methods of psychotherapy and each has its supporters, enthusiasts and promoters. Many schools direct teaching and practice of students. The best-known of psychotherapy used to treat depression include:

Psycho-dynamic therapy: In this method it is assumed that one can change the personality of the patient and the efforts are made to do this in the course of therapy. For this reason, its duration is always long, sometimes lasts even many years. The essential feature is its attempt to influence the mental processes of thinking outside of the patient. Analysis is made of unresolved childhood conflicts, which are regarded as essential reasons for low self-esteem. Through the efforts of the therapist and the patient is to obtain insight into the disturbed elements of personality and their repair. This has to lead to obtaining a favourable personality changes. The therapist tries to play (in this type of psychotherapy) the role of an impartial and relatively passive person.

Cognitive therapy: Its aim is to identify erroneous associations and improper track of the patient's thinking. Patterns result from the negative evaluation of the world, oneself and all the events that concern the patient. Working with a therapist is to analyse and modify this thinking. In numerous examples, given by the patient one can indicate the possibility of alternative interpretations. The goal of therapy is to get the patient a different way of perceiving and analysing the world and the events. This therapy is strongly oriented on the patient's current symptoms. the active role of the therapist and the relatively short duration (limited only to the period of depression) are characteristic for it.

CBT – cognitive behavioural therapy, it stands out among the best documented forms of psychotherapy efficacy in the treatment of depressive episodes. It is recommended for the treatment of affective disorders by among the others the British institute - National Institute for Health and Clinical Excellence (NICE). National Health Service (NHS, the British equivalent of the Polish National Health Fund) is required to guarantee the insured person treatment recommended by NICE institute because of its proven effectiveness. Based on current medical and psychological knowledge, as well as research on the effectiveness of cognitive-behavioural therapy, this type of psychotherapy is recommended for depression in patients with mild or moderate severity of illness. In case of severe depression, CBT is recommended to be combined with the antidepressants. The combination of these two forms of therapy is more effective than each of them separately. It happens sometimes that, despite pharmacological treatment a relapse occurs or that the patient simply prefers psychological treatment - then cognitive-behavioural psychotherapy is recommended. During the cognitive-behavioural therapy patient / client is working together with the therapist on the currently experiencing difficulties in his/her life. Usually it is the psychologist or psychiatrist who is certified cognitive-behavioural therapist, or is undergoing specialist training in CBT, accredited by the Polish Association for Cognitive and Behavioural Therapy (PTTPB). CBT helps to understand the problem. As the name cognitive-behavioural therapy implies, it seeks to change the way of thinking (cognitive sphere) and behaviour (behavioural sphere). This in turn has also influences positively on the emotional sphere. The therapist helps you learn new, adaptive ways of coping and functioning that are more effective than hitherto.

Interpersonal therapy: It is based on the belief that symptoms of depression and the development of the disease have their origin in inadequate interpersonal relationships. They should therefore, according to the authors of this method, be analysed and understood. During the session the patient's interpersonal relationships are analysed and the role of the therapist is active and supportive here. After a thorough analysis carried out in relation to the proposed solution strategy is determined by this interpersonal problem.

As an alternative to traditional schools of psychotherapy:

laughter therapy: As Alexander Lamek writes – people in depression often are in permanent stress. Meanwhile, laughter has a great anti stress effect. It allows you to de-stress both mind and body. When we are laughing, we put the whole body in vibration, the blood begins to circulate quickly, various organs are massaged, the breath deepens. This means that all tensions and stress-related blockades in the body start to let up. At the same time increased physiological activity has a positive effect on the mind. While laughing, we forget about everyday problems. They become less bothersome. Such therapy is particularly valuable for people with depression, for whom it is very difficult to get out of the "depressing" emotions. Another benefit of laughter therapy are its motivational properties. Laughter improves our mood and creates more positive vision of ourselves and the world, gives us a "kick" that makes it easier to undertake different actions. This is a very important advantage, because lack of willingness to do anything is a very common symptom for people with depression. For the patients relationships with other people are often a big problem. And here also the laughter can help thanks to its positive interpersonal qualities. It is worth mentioning about the impact of laughter on our health. It counteracts many diseases and strengthens the immune system. This is important information for people with depression, who as a result of weakened organism are more likely to get ill. The efficiency of the laughter therapy increases if we have the help of other people (spouse, children, parents, friends). Such people can become a kind of trainers of laughter therapy. They will motivate a sick person and encourage him/her to exercise and will also take part the exercises.

OTHER METHODS OF TREATMENT

Sometimes electro-convulsive therapy is used to treat depression. For many years, until the mid-50s it was considered the only effective therapeutic tool in the treatment of melancholia. Currently, psychiatrists use electro-convulsive therapy only when the patient's condition is especially severe when the drugs are ineffective or contraindicated. The conditions in which surgery is performed have also completely changed - it is done in a short general anaesthesia, giving curare, which prevents the occurrence of convulsions of the whole body, artificial respiration is applied, and many other improvements that make the electric shocks absolutely safe.

Among the methods supporting the treatment of depression are also: sleep therapy, photo-therapy, or proper diet.

Sleep therapy may be supportive and healing properties here are paradoxical. The method is total or partial deprivation of sleep at night. Apparently, sleep deprivation causes an immediate improvement in mental status in 60% of patients, unfortunately - only temporary, for the duration of deprivation. In the situation of a return to natural sleep habits (or disorders), the patient returns to the level before application of sleep therapy.

Photo-therapy is especially helpful in treating seasonal depression in autumn - winter. During the session the patient usually goes into the room painted white, lit a lamp emitting a bright light with intensity of not less than 2500 lux ( the power of the lamp at home is 300-500 lux). This light does not contain UV radiation, therefore it is not harmful, does not burn and does not harm the eyes. Often during a session soothing music is on which additionally allows to relax well . Exposure time depends primarily on the intensity of the rays, but usually lasts from 15 minutes to an hour. Usually it is 5 to 10 treatments. Before photo-therapy treatment you should first consult a physician. those who take medications that cause a strong reaction to light and people with sick eyes can not be treated with this method. Sometimes during irradiation nausea, hands tingling , and headaches may appear. These symptoms must be reported to your doctor immediately. Photo-therapy is usually offered by some wellness and natural medicine clinics. It is also often used by psychiatrists and neurologists. In Poland, the home version of the lamp for photo-therapy was constructed, it is called Fotovita. The use of such lamp at home is absolutely safe, it does not require using sunblock and does not spoil your eyes. But keep in mind that photo-therapy is a form of light therapy and should be used if indicated by a specialist - unjustified irradiation did not improve well-being, and can only cause headaches and eye irritation.

Because depression affects the mental state of individuals seeking treatment methods one should also draw attention to diet. Experts of nutrition argue that products such as sugar, caffeine, alcohol and saturated animal fats have a negative effect on mood, but there are also products that can act positively on psyche. The report, entitled "Feeding Minds" draws attention to imbalance between the nutrients consumed over the last five decades. Spread food production on an industrial scale had bad influence on our diet, use of pesticides and change of the composition of animal fats, resulting from changes in the mode of feeding animals. In recent years greatly increased consumption of saturated fats, because of the spread of the ready-made meals. According to the report, the British consume about 34% less vegetables and two thirds less fish, which can affect the onset of depression, schizophrenia and Alzheimer's disease. Within the project "Food and Mood", organized with the support of the UK's Mind organisation, dealing with the promotion of concern for mental health, research on the psychological impact of diet was conducted. It turned out that 88% of respondents felt a significant improvement in mood and mental performance after changing the diet. According to 26%, a change of diet helped them get rid of mood swings, and about 25% of respondents noticed reduction in the number of panic attacks, anxiety and depression. Research conducted at the University of British Columbia have shown that fish consumption increases levels of serotonin - the hormone responsible for mood, sleep, sexual needs and impulsive behaviour. Andrew Stoll of Harvard University has demonstrated the effectiveness of fish fats in relieving the symptoms of bipolar disorder (occurring alternately depressive and manic states), and Malcolm Pett of Sheffield University, noted improvement in 69% of patients, who, after unsuccessful Prozac treatment, were given high doses of omega fatty acids, found in fish meat. Apart from omega acid contained in fish, another compound having, according to recent studies, a significant impact on improving mood, is tryptophan. Such dishes as turkey, bread, milk, cheese and bananas include significant amounts of tryptophan. Wim Riedel of the University of Maastricht, published in "Brain, Behaviour and Immunity" research on the effects of tryptophan levels on the ability of memory and mood. 27 volunteers were examined,16 of them had in their family of a person prone to depression. Participants of the experiment were lowered the level of tryptophan, and then their memory and mood were tested. It turned out that the memory capacity decreased in all subjects, while in the group of participants whose relatives had a tendency to depression, its symptoms were also found. The researchers emphasize that diet should be considered particularly susceptible to depression prone people those who undergo immunotherapy because such treatment causes a reduction in the level of tryptophan. We encourage you to complete the test on nutrition. The professional report will tell you if you eat properly as well as ensure you that the food has become part of the healing is not only fitting but a lifetime.

HOW TO LIVE WITH DEPRESSION?

Depression undoubtedly is a complex phenomenon and requires a specialized and comprehensive treatment. No treatment, however, will be effective if the patient does not want to get well. Here are some advice on how to cope with depression:

Take medications as prescribed.

Remember that antidepressants do not work immediately.

Do not stop taking the medicine or decrease the dose just because you felt better.

Visit your doctor regularly

Any doubts should be consult with your doctor, do not follow contingently heard opinions.

Develop your knowledge about the disease. It will be easier for you to face it.

Be patient - depression will not disappear within a week.

Remember that the first treatment may not help, you may need to change it and start all over again.

Lower your expectations of yourself and do not take too much responsibility on you.

Do not make any important decisions the during the time of illness.

Try to have less stress in your life. You can check what is your stress level by filling in our stress test. From the report you will learn how to cope with the symptoms of stress, which you are going through.

Do not try to better your mood with alcohol or other stimulants. Even if you feel better for a moment, depression will intensify.

Remember that your family may not understand your suffering. Depression is not easy even for your milieu.

Despite the pain, try to keep physical activity; exercise, go for walks - do as much as you can.

Give yourself little pleasures.

Remember that depression is treatable.

WHAT IF IT IS NOT YOU WHO SUFFERS FROM DEPRESSION?

If in your milieu there is a person to whom you would like to say "pull yourself together" because recently he/she sits and complains, do not do this until you are absolutely sure that it is just a blues not a depression. For patients taking any decision is really painful. The first sign that it is something more than the blues should be his/her withdrawal from relationships and social contacts. If a person falls out of the roles previously carried, ceases to be a parent or a spouse and isolates from family at the same time, or suddenly stops doing his/her professional duties, forgetting about the role of employee – it is a signal that a visit to a specialist should be considered. Below you will find some tips on how to help him/her.

Do not treat depression as laziness, poor character, bad will. Depression is an illness such as flu and hypertension.

Do not give such advice like "pull yourself together" or "shake off". You do not you give them to people with a heart attack or a stroke.

Do not send him/her on short vacation to rest. Depression needs to be treated.

If you suspect a person close to you of depression – persuade him/her to visit a psychiatrist or psychologist. They know the best what to do. If you fail, at least try to consult your family doctor (or a doctor, to whom the patient believes).

If you have problems convicting him/her about the need for treatment turn for help to a person who is for him / her the authority.

Remind the patient about visits to the clinic and taking medication regularly. Too early discontinuation is the risk of the relapse of the symptoms.

Do not try to amuse him/her or to organize his/her time.

Do not impose yourself on him/her, but stay close, offering your help when needed.

Be patient and understanding. A lot of additional responsibilities may fall on your shoulders.

Remember that depression can be cured. Try to instil this belief in the ill person.

Advise the ill person against making important decisions. He sees his affairs in a "bleak". He/she is very pessimistic about the future.

Avoid accidentally overheard opinion. Gather as much reliable knowledge about depression as possible.

Treat all statements about suicide seriously. It is not true that if someone talks about suicide he/she will not commit it.

Remember about yourself. The disease of somebody dear may raise frustration, anger, helplessness, feelings of guilt. It is understandable. Do not be ashamed to seek advice from a psychologist, how to deal with those feelings.